Table 3.
Lung Cancer Diagnostic Methods
| Diagnostic method | Sensitivity (%) | Specificity (%) | Indication | Comments |
|---|---|---|---|---|
| Invasive diagnostic test | ||||
| Thoracocentesis | 80 | >90 | Pleural spillage | Pleural fluid cytology |
| Thoracotomy | – | – | Only clearly resectable tumors | Recommended for diagnosis and treatment of early nonsmall cell carcinoma |
| Excisional biopsy of an accessible node | – | – | Palpable lymphadenopathy | – |
| Flexible bronchoscopy with or without transbronchial needle aspiration | Central tumors: 88 Peripheral tumors: 60–70 | 90 | Central or peripheral tumors and mediastinal lymphadenopathy | Fluoroscopic or CT guidance; transbronchial needle aspiration improves sensitivity in peripheral tumors |
| Transthoracic needle aspiration | Peripheral tumors: 90 | 97 | Peripheral tumor in nonsurgical candidates or when transbronchial needle aspiration is inconclusive | Fluoroscopic or CT guidance; the assistance of a cytopathologist improves diagnostic yield |
| Video‐assisted thoracoscopy | – | – | Small peripheral tumors (<2 cm in diameter), pleural tumors, or pleural effusions | May prevent the need for thoracotomy |
| Noninvasive diagnostic test | ||||
| Sputum cytology (at least three specimens) | Central tumors: 71 Peripheral tumors <50 | 99 | Central tumor and haemoptysis | Noninvasive; further testing needed after negative result |
| Computed tomography | 80–90% | – | – | Positive predictive value less than 20% in lung cancer screening |
| Magnetic resonance imaging | 94% | 95% | To differentiate malignant SPNs from bening SPNs | To evaluate microvessel density, staging lung cancer and for a treatment followup |
| Chest radiography | 54–84% | 90–99% | To detect presymptomatic disease and initial diagnosis | 3–5% of lung lesions are identifiable only with lateral X‐rays, and 5–17% can be observed better laterally than frontally |
| 18F‐FDG positron emission tomography | 96% | – | Evaluating on indeterminate SPNs | Emerging as a pre‐operative assessment in NSCLC. Combined with CT Scan improves accuracy |
SPNs, solitary pulmonary nodules. –: Nonspecified.
aAdapted with permission from “Lung Cancer: Diagnosis and Management,” January 1, 2007, American Family Physician. Copyright © 2007 American Academy of Family Physicians. All rights reserved” Information added from 30, 32–35.